Meniscus tear

Triathlon Forum
1

Hi,

I need some advice regarding an arthroscopy l had last year to repair a medial meniscus tear and a plica resection, and the possibility that l may now need surgery to fix a torn meniscus in the other knee.

I’m 26 years old, and prior to the operation, l was cycling around 150-200 miles a week, participating at 3rd/4th cat races and weekly time trials.

Following a busy season, l developed pain in my right knee while riding home from work. This turned out to be a plica, which my surgeon operated on, while also using the opportunity to sew up a tear in the medial meniscus (which was not symptomatic at that point).

After a very protracted recovery (I’m still not back training), l am left with an occasional sharp ache in the medial region of my knee, and a painful, sore sensation in a localised area below and to the medial side of my right kneecap, near the arthroscopy portals. This flares up painfully during exercise, and l am currently confined to swimming as a result.

I have recently changed physiotherapists, and it was recommended to me that l work at strengthening my legs as l have lost a lot of strength, thereby causing me knee to hurt. I am currently working at this, although the exercises tend to leave the knee sore – seems like a vicious circle.

In addition, l have recently discovered that my left knee has a medial meniscus tear. This manifests itself as a sharp, sore pain within my knee, although to this point l have not suffered any catching or locking as one may associate with such an injury.

My question is this – Does anyone have any experience of such a situation? I believe my only options are to wait for a few months, try and strengthen the muscles around my knee, and see what happens, or a have the surgery asap, and see how that goes. My current thinking is to get the surgery done, as either way, it will mean a good few months off the bike, and at least l should have a fixed knee in the end???

The thing that puzzles me is that up until the operation, the tear in my right knee was asymptomatic, and my left knee only began bothering me around five months after the operation, when l wasn’t riding, so therefore it seems to that the tear was there for a lot longer.

Could it be that my legs were strong enough to cope while the tear was there?

Sorry for the long letter – l’m getting desperate and am afraid I’ll never be competitive on the bike again.

Many thanks

2

D- any thoughts toward repeat MRI of the right knee to determine the source of continued complaints? If I read this correctly, it wasn’t symptomatic, you had an operation to “fix” it, and now it is symptomatic. If this is June, and you had the surgery “last year” then many folks with a meniscus repair would already be back in the thick of things. Any ideas as to what type of tear it was or what was used to repair?

With respect to the left knee, not all meniscus tears can/need to be repaired. I don’t know that I’d be in a big hurry to have it “fixed” until I got the right knee to it’s greatest potential.

3

Hi John, thanks for the quick reply.

I’m afriad l dont have the MRI report for the left knee to hand - l will post this later on. Suffice to say that it is sore and l’m worried that any stress on it (gym / bike) will make it worse. Hence why l am thinking of getting it looked at sooner rather than later.

With regards the operated knee, l had an MRI which came back clear - that is, no apparent new tear (the tear site was noted, but apparently this is normal). The portals were apparent, there was no effusion, and only a small osteochondral defect which is asymptomatic.

My surgeon said pretty much the same thing - l should be ‘on it’ again. I am currently not riding as l am trying to completely rest the knee, however a 4 week period of riding ending around a month ago left the knee in pain (particularly around the portal), with the odd ‘twinge’ from the meniscus. Do you think it would be safe to ignore the meniscus soreness? I’m wondering if the sensations l’m getting are normal for such an operation?

Many thanks,

4

I don’t have specific advice for your injuries, but two things came to mind reading your post.
First, I know it’s been a long time, but don’t stop being patient. You want to fix this so that it stays fix.
Second, you want the people you’re working with to be people you fully trust. I got the sense in reading your post that you were skeptical of the people who were working on you. Shop around. Get 2nd opinions. If your insurance doesn’t cover it, pay for it. Yes, that sucks, but you won’t get a 2nd pair of legs.
and maybe after the 2nd opinion you’ll have a better trust of the first doc.

5

Bob Loblaw has some good thoughts. Although there’s some potential of something, say a neuroma, at the arthroscopy portal causing pain, that would be exceedingly rare. And, if the repaired tear is healed by MRI criteria, is there a different source for the pain?

6

Simply put, I would recommend getting a second opinion. It’s crucial that you have a good surgeon when doing operations such as these. I knew a couple people back in college who still were not a 100% after they had their surgeries (ACL and meniscus).

I had a torn meniscus last year, and I was given the choice between rest and physical therapy versus surgery. Assuming you have a good surgeon, I would pick surgery because the outcome is more predictable than just rest and PT. You don’t know how the knee will respond to PT. If you opt to go through the surgery route, the surgeon will go in and remove the frayed meniscus and smooth the surface so there’s no chance of further damage. The removal and smoothing is far more common because only vertical tears in meniscus can be sutured and repaired.

If you are in the Los Angeles area, I can give you the name of my surgeon. He’s highly-regarded and an excellent surgeon.

7

Regarding needing the other knee done. I had a somewhat similar experience. I went in with pain in one knee, it went away and the other knee became painful. I had surgery on the second knee and was told it was common that after hurting one knee you can tweak the other while trying to compensate. I was told that I should expect to have the other knee done soon after my first (MRI is not an option for me) , with similar statements about using PT to strengthen the muscles to prepare for the next surgery and get me back in action again. HOWEVER, i have managed to avoid this second surgery but I have to work hard at it. I use a foam roller to keep my IT bands in great shape and avoid situations that require full range of motion (IE – I always use the ladder getting out of the pool b/c it can sometimes tweak my knee to pull myself out on the side). I also take supplements (baxyl) and try to do short runs often (as opposed to long).

One thing, when you say last year, did you mean 12 months ago, or that you had your surgery in 2009? I read plenty of posts on ST about people who were out running in 6 weeks after surgery. I had straight up partial meniscectomy (sp) (no ACL or anything else). I found that it was a full 12 months (probably even a bit more) before I felt like I could get back to running anything more than 1 -2 miles without pain. I did not understand if I just babied myself and was paranoid about every twinge but after about that amount of time I got much better at being able to add more mileage. As far as biking I was on a bike about 5 days post op – slow but pedaling. Swimming was two weeks after.

8

Hi guys,

Thanks for all the advice. I have recently spoken with my surgeon again and he suggested that l was strong enough to go through with the surgery (left knee, medial meniscus repair) provided l took it easy in the following weeks.

I have one more question for you however:

I have been ramping up my cycling a little more lately, and l am aware of a clicking sensation in / around the kneecap (right knee)that has been there since the scope last november, but only really noticeable lately. The kneecap is ‘squeaky’ and tends to become hot over the course of the ride. In addition, it produces a loud click that l can replicate pretty much at will.

My surgeon has suggested it is scar tissue, and that it should break down during exercise, however l would like to know whether this is definetely the case (i’m after a second opinion basically.) I dont want to find out that after my latest surgery, that l have to go back in and have scar tissue removed, thereby holding me back from returning to sport.

9

The popping sure sounds like the exact thing I have, a condral flap under your patella. I am having it shaved off tomorrow morning with the possibility of microfracture of OATS procedure if the damage warrents it. Surgeon won’t know how he will proceed until the camera is in there for a close up look.

Generally, getting old sucks, but I have heard enough good stories to keep my faith and hope for the best.

10

I had meniscus surgery along with microfracture surgery in Feb.

I started to ride 7 weeks after surgery (really short and slowly) and had clicking in that knee initially which was from scar tissue. Self massage of the incision sites really helps to break this up and that has now gone away when I ride. It never hurt just felt a bit strange. I have found that I get a bit of clicking in my knee from time to time off the bike and my Dr and Physio attribute this to the kneecap not tracking properly due to muscle imbalance. As I have worked to strengthen my legs the clicking is becoming more infrequent.

Can’t comment on how running might be as I am a good 3 months or so from even trying.

Good luck

11

Assuming the tears are repaired and pieces put back together, the rehab’s job is to re-establish the strength and, ideally, re-establish strength balance. If you have a musculoskeletal injury (or injury of musculoskeletal origin) you have an inability to absorb force. Your assessment may very well be correct (key words “may be”). Prior to surgery, you may have had the strength to absorb, and after surgery, you no longer had this ability.

By the way, I bet your surgeon did a great job of repairing the tear.

Rarely is one’s pain or symptom (tear in the meniscus) the same spot where the problem is.

So if your assessment is correct, and your lack of strength is the problem, one symptom has been fixed (tear), another symptom is worse (pain level), but hopefully your new PT can help you identify and train your weaknesses and re-establish strength balance. This should reduce or eliminate the pain.